JP2014527852A - Implant retention loop and guidewire extension - Google Patents

Abstract

A surgical assembly comprising a first guide wire and a second guide wire, each of the first guide wire and the second guide wire being configured to be received by a bone block Further including a first suture loop, a second suture loop, a first fixation element, and a second fixation element, wherein the first fixation element is coupled to the first suture loop; And the surgical assembly wherein the second anchoring element is secured to the second suture loop.

Description

  The cause of anterior lower shoulder joint instability is multifactorial. Fracture fractures of the anterior scapula glenoid fossa, so-called bone bankart lesions, are associated with anterior lower shoulder joint instability. Successful treatment of this condition requires a surgical procedure that can identify and repair related lesions that can cause shoulder instability.

  Currently, anterior inferior shoulder instability associated with lesions in soft tissue can be successfully treated with arthroscopy, and the clinical results are generally similar to those seen after open surgery. is there. However, the main risk of instability recurring after arthroscopy treatment is related to the presence of additional bone defects in the glenoid when compared to open surgery. Current methods of repairing osseous bankart, or treating anterior lower shoulder joint instability, push / pull bone block with grasper in the body, and fix bone block with sutures and screws Including that. Manipulating the bone block in the body using a grasper and securing the bone block in the body using a suture are difficult for the surgeon and can be time consuming as a result.

  Accordingly, there is a need for improved techniques for treating anterior lower shoulder joint instability.

  According to one aspect of the present invention, a surgical assembly is provided, the assembly including a first guidewire and a second guidewire, wherein the first guidewire and the second guidewire are Each configured to be received by a bone block, further including a first suture loop, a second suture loop, a first fixation element, and a second fixation element; A securing element is coupled to the first suture loop, and a second securing element is coupled to the second suture loop.

  According to another aspect of the present invention, a surgical method is provided, the method comprising forming a posterior portal in the body, forming an anterior entrance in the body, a first guide wire and a first guide wire. Inserting a second guide wire into the posterior entrance; pulling each of the first guide wire and the second guide wire out of the body through the anterior entrance; the first guide wire and the second guide wire; Positioning each of the guidewires through the bone block; securing the first suture loop to the first guidewire and securing the second suture loop to the second guidewire; Using the guide wire and the second guide wire, the step of placing the bone block into the body through the anterior entrance and the step of removing each of the first and second suture loops. And fixing the bone block in the body with respect to the glenoid fossa.

  In accordance with another aspect of the present invention, a surgical kit is provided that passes through a hole formed proximally and configured to receive a bone block, a proximal end, a distal end, and the like. A first cannula having a defined central axis; a first guide wire; a second guide wire; a first suture loop comprising a first securing member; and a first securing member comprising a second securing member. 2 suture loops.

1 is a perspective view of a surgical assembly according to an embodiment disclosed herein. FIG. FIG. 3 is a view of a surgical assembly according to an embodiment disclosed herein. FIG. 3 is a view of a surgical assembly according to an embodiment disclosed herein. FIG. 3 is a view of a surgical assembly according to an embodiment disclosed herein. FIG. 3 is a view of a surgical assembly according to an embodiment disclosed herein. FIG. 3 is a view of a surgical assembly according to an embodiment disclosed herein. FIG. 3 is a view of a surgical assembly according to an embodiment disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein. FIG. 10 illustrates a method of using a surgical assembly in a body in accordance with embodiments disclosed herein.

  The following description is directed to various exemplary embodiments of the present disclosure. While one or more of these embodiments may be preferred, the disclosed embodiments should not be construed as limiting the scope of the disclosure, including the claims. Or should not be used in any other way. Furthermore, one of ordinary skill in the art will appreciate that the following description has a wide range of uses, and that discussion of any embodiment is merely illustrative of the embodiment, and claims It will be understood that the scope of the disclosure, including the scope, is not meant to be limited to that embodiment.

  Several terms are used throughout the following description, and the claims refer to specific features or components. As will be appreciated by those skilled in the art, the same mechanism or component may be indicated by another person under a different name. This document does not intend to distinguish between components or mechanisms that have the same function but different names. The figures are not necessarily drawn to scale. Some features and components herein may be exaggerated in scale or somewhat in schematic form, and some details of conventional elements may be clarified and It may not be shown for brevity.

  In the discussion below and in the claims, the terms "including" and "including / comprising" are used in an open form and thus "includes but is not limited to". Further, the terms “couple” or “couples” are intended to mean indirect or direct connections. Thus, when the first component is coupled to the second component, the connection can be by direct connection or by indirect connection through other components, devices, and connections. Further, the terms “axial” and “axially” generally mean along or substantially parallel to the central axis or longitudinal axis, but the terms “radial” and “radially” "Is generally meant to be perpendicular to the center, longitudinal axis.

  Further, terms indicating directions such as “up”, “down”, “upper side”, “lower side” are used for convenience in reference to the accompanying drawings. In general, “upper”, “upper”, “upper”, and similar terms refer to the direction from below the surface along the borehole to the ground, "Down" and similar terms refer to the direction away from the surface along the borehole, i.e., the direction within the borehole, but this is for illustration only and the terms limit the present disclosure It doesn't mean that.

  Referring now to FIG. 1, a perspective view of a surgical assembly 100 according to an embodiment disclosed herein is shown. In one or more embodiments, the assembly 100 includes a first cannula 101, a first guidewire 111, a second guidewire 112, a first suture loop 121, a second suture loop 122, A first fixing member 123 and a second fixing member 124 can be included. As shown, each of the first guide wire 111 and the second guide wire 112 is configured to be received by the bone block 110. As further shown, the first anchoring element 123 is coupled to the first suture loop 121 and the second anchoring element 124 is coupled to the second suture loop 122.

  In one or more embodiments, the first cannula 101 has a hole 109 formed therethrough, a proximal end 105, a distal end (not shown), and a defined central axis therethrough. 150 can be included. In one or more embodiments, the hole 109 of the first cannula 101 can be configured to receive a bone block / graft, such as the bone block 110, for example. As discussed below, in one or more embodiments, the first guide wire 111 and the second guide wire 112 are used to place the bone block 110 inside the hole 109 of the first cannula 101. And the bone block 110 can be repositioned or reoriented so that it can be moved through the first cannula 101. For example, in one or more embodiments, the bone block 110 includes the first guidewire 111 such that the longitudinal axis of the bone block 110 is substantially parallel to the central axis 150 of the first cannula 101. And can be repositioned or redirected by the second guidewire 112. Furthermore, the first guide wire 111 and the second guide wire 112 can be used to move or transfer the bone block 110 through the first cannula 101 and into the body (not shown).

  In one or more embodiments, each of the first guidewire 111 and the second guidewire 112 is made from any substantially rigid material known in the art, or any flexible It can be formed from a material. For example, each of the first guide wire 111 and the second guide wire 112 can be made of plastic or a metal such as Nitinol. Further, in one or more embodiments, each of the first guidewire 111 and the second guidewire 112 can be a looped guidewire. In other words, in one or more embodiments, the first guidewire 111 can include a first loop 117 and the second guidewire 112 can include a second loop 118. . In one or more embodiments, the first loop 117 of the first guidewire 111 and the second loop 118 of the second guidewire 112 are configured to receive the suture loops 121, 122, respectively. be able to. Although FIG. 1 shows an embodiment of a surgical assembly 100 that includes only two guidewires 111, 112, those skilled in the art will appreciate that more or less than two guidewires can be used. Like. For example, in one or more embodiments, 1, 3, 4, or more guidewires may be used.

  In one or more embodiments, the first suture loop 121 can be configured to be secured to the first guidewire 111 and the second suture loop 122 can be configured as the second guide. It can be configured to be fixed to the wire 112. For example, as shown, the first suture loop 121 is configured to be secured to the first loop 117 of the first guidewire 111, and the second suture loop 122 is The guide wire 112 is configured to be fixed to the second loop 118. As will be discussed below, in one or more embodiments, a first suture loop 121 and a first securing member 123 are used to secure the first loop 117 of the first guidewire 111 to the first loop 117. The suture loop 121 is moved through the first loop 117 of the first guidewire 111 to create or pass the loop, and is also moved back through itself to create the loop, Or let it pass. Similarly, to secure the second suture loop 122 and the second securing member 124 to the second loop 118 of the second guidewire 112, the second suture loop 122 is connected to the second guidewire. It can be moved through the second loop 118 of 112 to create or pass the loop, and it can be moved back through itself to make or pass the loop. In one or more embodiments, the first suture loop 121 and the second suture loop 122 are respectively removed or disengaged from the first guide wire 111 and the second guide wire 112, respectively. To do so, the surgeon can pull each of the first fixation member 123 and the second fixation member 124 in a direction substantially away from each of the guidewires 111,112. By pulling each of the first fixing member 123 and the second fixing member 124 in a direction substantially away from each of the guide wires 111 and 112, each of the suture loops 121 and 122 is unwound or the loop is released. And the engagement with each of the guide wires 111 and 112 can be released.

  Further, in one or more embodiments, each of the first suture loop 121 and the second suture loop 122 is art-recognized, such as a suture, plastic, or malleable metal such as Nitinol. It can be formed from any known flexible material. In one or more embodiments, each of the first suture loop 121 and the second suture loop 122 can be a closed continuous loop. Alternatively, in one or more embodiments, each of the first suture loop 121 and the second suture loop 122 can be closed and include a knot (not shown).

  As discussed above, in one or more embodiments, the first fixation element 123 is coupled to the first suture loop 121, and the second fixation element 124 is the second suture loop. Can be fixed to 122. A person skilled in the art will attach the first and second fixation elements 123, 124 to the first suture loop 121 and the second suture loop 122, respectively, by any means known in the art. It will be understood that they can be combined. For example, the first anchoring element 123 and the second anchoring element 124 are respectively connected to the first suture loop 121 and the second suture loop 122 by mechanical or chemical means such as crimping, molding, or gluing. Can be combined. Alternatively, in one or more embodiments, each of the first fixation element 123 and the second fixation element 124 can include a hole formed therethrough, e.g., a bead or necklace, etc. As such, the first suture loop 121 and the second suture loop 122 can be threaded through each of the first fixation element 123 and the second fixation element 124. As shown, each of the first fixing element 123 and the second fixing element 124 has a substantially spherical shape. One skilled in the art will appreciate that the shape of the first fixation element 123 and the second fixation element 124 can be any shape known in the art. For example, the shape of each of the first fixation element 123 and the second fixation element 124 can be a sphere, a hemisphere, a cube, a prism, a pyramid, or any other shape known in the art. . Further, each of the first fixation element 123 and the second fixation element 124 can be formed from any material known in the art. For example, in one or more embodiments, each of the first fixation element 123 and the second fixation element 124 is formed from metal, plastic, ceramic, or any other material known in the art. be able to. Alternatively, each of the first fixation element 123 and the second fixation element 124 can be formed from any biocompatible material known in the art.

  Referring to FIGS. 2A-2F, there are shown multiple views of a surgical assembly 200 according to embodiments disclosed herein. In one or more embodiments, the assembly 200 includes a first cannula 201, a first guidewire 211, a second guidewire 212, a first suture loop 221, a second suture loop 222, A first fixing member 223 and a second fixing member 224 can be included.

  As shown in FIG. 2A, the first cannula 201 includes a hole 209 formed therethrough, a proximal end 205, a distal end (not shown), and a defined central axis 250 therethrough. In one or more embodiments, each of the first guide wire 211 and the second guide wire 212 passes through the end of the first cannula, such as the distal end, for example, within the first cannula 201. Or can be moved through the first cannula 201 and exit through the proximal end 205 of the first cannula 201. As discussed above, each of the first guidewire 211 and the second guidewire 212 is made from any substantially rigid material, or any flexible material known in the art. Can be formed. For example, each of the first guide wire 211 and the second guide wire 212 can be made of plastic or a metal such as Nitinol. Further, in one or more embodiments, each of the first guide wire 211 and the second guide wire 212 can be a looped guide wire. In other words, as shown, the first guidewire 211 can include a first loop 217 and the second guidewire 212 can include a second loop 218.

  As shown in FIG. 2B, the first guide wire 211 can be placed through the first cannula 201 and through the bone block 210. As shown, the bone block 210 includes two holes 219A, 219B, which are configured to receive a first guide wire 211 and a second guide wire 212, respectively. One skilled in the art will appreciate that the bone block 210 can be any bone block or bone graft that can be used in a surgical procedure. For example, in one or more embodiments, the bone block 210 can be used to treat anterior lower shoulder joint instability in the body. Alternatively, the bone block 210 may be an appropriately sized and shaped bone block or bone graft, eg, an appropriately sized, that can be used in surgical procedures involving the hip, knee, wrist, or ankle of the body. Can do.

  After the first guide wire 211 is placed through the bone block 210, the first suture loop 221 is moved through the first loop 217 of the first guide wire 211, as shown in FIG. , Make a loop, or pass through. As further shown, a first anchoring element 223 is coupled to the first suture loop 221. As discussed above, in one or more embodiments, the first anchoring element 223 can be coupled to the first suture loop 221. One skilled in the art will appreciate that the first anchoring element 223 can be coupled to the first suture loop 221 by any means known in the art. For example, the first securing element 223 can be coupled to the first suture loop by mechanical or chemical means such as crimping, molding, or gluing. Alternatively, in one or more embodiments, the first anchoring element 223 can include a hole formed therethrough, such as a first suture loop, such as a bead or necklace. 221 can be passed through the first fixing element 223.

  As shown in FIG. 2D, in order to secure the first suture loop 221 and the first securing member 223 to the first loop 217 of the first guidewire 211, the first suture loop 221 is further For example, it can be moved back in itself in the direction of arrow P to create or pass a loop. As discussed above, in one or more embodiments, the first suture loop 221 can be any suture known in the art, such as suture, plastic, or malleable metal such as Nitinol. It can be formed from a flexible material. In one or more embodiments, the first suture loop 221 can be a closed continuous loop. Alternatively, in one or more embodiments, the first suture loop 221 can be closed and include a knot (not shown).

  As shown in FIG.2E, the first suture loop 221 is moved through the first loop 217 of the first guidewire 211 to create or pass the loop, and even back through itself. After moving, creating or passing the loop, the first suture loop 221 can be attached to the first suture loop 221 to secure the first suture loop 221 and the first securing member 223 to the first guide wire 211, for example Tension can be applied substantially in the direction of arrow P in FIG. 2D. One skilled in the art will appreciate that the first suture loop 221 can be secured to the first guidewire 211 by other methods known in the art other than those described above. For example, the first suture loop 221 can be tied to the first guide wire 211 with a knot. Alternatively, to secure the first suture loop 221 to the first guidewire 211, the first suture loop 221 is moved through the first loop 217 of the first guidewire 211; A loop can be made or passed through, and the end of the first suture loop 221 wraps around or wraps around the opposite end of the first suture loop 221 Can do. As further discussed above, in one or more embodiments, in order to remove or disengage the first suture loop 221 from the first guidewire 211, the surgeon may 223 can be pulled in a direction substantially away from the first guidewire 211. By pulling the first fixing member 223 in a direction substantially away from the first guide wire 211, the first suture loop 221 is released or the loop is released, and the engagement with the first guide wire 211 is performed. Can be canceled.

  Referring now to FIG. 2F, a perspective view of an assembly 200 according to an embodiment disclosed herein is shown. As shown, the same procedure as shown in FIGS. 2B-2E and described above with respect to the first guidewire 211 and the first suture loop 221 is as described above. It can also be applied to the suture loop 222. For example, in one or more embodiments, the second guidewire 212 can be placed through the hole 219B in the bone block 210. Further, in one or more embodiments, the second suture loop 222 can be moved through the second loop 218 of the second guidewire 212 to create or pass the loop. Further, in one or more embodiments, a second suture loop is used to secure the second suture loop 222 and the second securing member 224 to the second loop 218 of the second guidewire 212. 222 can also be moved back, for example, in the direction of arrow P in FIG. 2D to create or pass a loop. Further, in one or more embodiments, the second suture loop 222 is moved through the second loop 218 of the second guidewire 212 to create or pass the loop further through itself. After moving back, creating or passing the loop, the second suture loop 222 is secured to secure the second suture loop 222 and the second securing member 224 to the second guidewire 212. In addition, for example, tension can be applied substantially in the direction of arrow P in FIG. 2D. As discussed above, the bone block 210 is connected to the first guide wire 211 and the second guide such that the longitudinal axis of the bone block 210 is substantially parallel to the central axis 250 of the first cannula. The wire 212 can be repositioned or reoriented. Further, the first guide wire 211 and the second guide wire 212 can be used to move or move the bone block 210 through the first cannula 201.

  A surgical method according to embodiments disclosed herein includes forming a posterior entrance in the body, forming an anterior entrance in the body, and connecting a first guide wire and a second guide wire to the posterior entrance. Inserting the first guide wire and the second guide wire out of the body through the anterior entrance, and placing the first guide wire and the second guide wire through the bone block, respectively. Using the first guide wire and the second guide wire, fixing the first suture loop to the first guide wire and fixing the second suture loop to the second guide wire, and Placing the bone block into the body through the anterior entrance; removing each of the first suture loop and the second suture loop; It may include a step of fixing the body against the glenoid.

  In one or more embodiments, the step of placing the bone block in the body orients the bone block such that the longitudinal axis of the bone block is substantially parallel to the central axis of the first cannula. A step of attaching. In one or more embodiments, pulling each of the first guide wire and the second guide wire out of the body pulls each of the first guide wire and the second guide wire out of the body through the front entrance. A step of using a gripper can be included. Further, in one or more embodiments, placing the bone block in the body can include pushing the bone block through the first cannula using an obturator and into the body. In one or more embodiments, placing the bone block in the body includes pulling the bone block through the first cannula into the body using each of the first guide wire and the second guide wire. be able to. Further, in one or more embodiments, securing the bone block within the body includes securing at least one screw through the bone block and into the glenoid.

  The method also includes placing a guide with a hook through the posterior entrance into the body, placing the hook of the guide on the anterior side of the glenoid, and from the posterior side of the glenoid to the anterior side of the glenoid. Forming a first hole and a second hole through the glenoid and inserting a first cannula into the body through the anterior entrance, the first cannula formed through Comprising a hole, a proximal end, a distal end, and a defined central axis passing therethrough, and removing each of the first guide wire and the second guide wire from the body. .

  For example, referring now to FIGS. 3A-3R, a surgical method according to embodiments disclosed herein is shown. In one or more embodiments, the surgical assembly 300 includes a first cannula 301, a first guide wire 311, a second guide wire 312, a first suture loop 321, a second suture. A loop 322, a first fixing member 323, and a second fixing member 324 can be included.

  Referring to FIG. 3A, a spinal needle (not shown) can be inserted along the surface of the glenoid 340 from the posterior side of the glenoid 340 to the anterior side of the glenoid 340. According to one or more aspects, the spinal needle can be placed under the equator (not shown) of the glenoid 340, confirming the placement of the posterior instrument entrance (not shown) Can be used for. Once the posterior instrument entrance is formed, the hooked end 331 of the glenoid guide 330 can be placed in or inserted through the posterior instrument entrance. The hook-like end 331 of the glenoid guide 330 traverses the glenoid 340 substantially parallel to the glenoid surface to avoid damage to the articular surface and the anterior edge of the glenoid 340 You can pass over 341. The glenoid guide 330 can be rotated so that the hooked end 331 of the glenoid guide 330 can engage the anterior edge 341 of the glenoid 340. The hooked end 331 of the glenoid guide 330 can be placed at the 4 o'clock position and can be associated with the midpoint of a bone block (not shown). However, those skilled in the art will appreciate that the hook-like end 331 of the glenoid guide 330 can be placed anywhere on the glenoid 340. For example, the hooked end 331 of the glenoid guide 330 can be placed at the 2 o'clock position and can be associated with the midpoint of the bone block.

  Referring to FIG. 3B, when the hook-like end is placed, the first guide 333 can be placed in the upper hole (not shown) of the glenoid guide 330. A skin incision is made and the first guide 333 can be advanced into the body until it engages the posterior side of the glenoid 340. The first guide 333 can include a ratchet tooth 337 or thread that can engage a corresponding ratchet or thread of the glenoid guide 330. According to one or more aspects, the first guide 333 can be advanced, moved, and / or fixed into the body along the glenoid guide 330 using the ratchet teeth 337. . Similarly, the second guide 334 can also be placed in the body and can engage the posterior side of the glenoid 340. According to one or more aspects, the second guide 334 can be placed in a lower hole (not shown) in the glenoid guide 330. In addition, a first sleeve (not shown) and a second sleeve (not shown) can be placed in the first guide 333 and the second guide 334, respectively, on the posterior side of the glenoid 340. Can be engaged.

  Referring to FIGS. 3C and 3D, a first hole 349A and a second hole 349B can be formed through the glenoid from the posterior side of the glenoid 340 to the anterior side 341 of the glenoid 340. According to one or more aspects, a drill (not shown) can be disposed within each of the first guide 333 and the second guide 334 shown in FIG. 3B, for example, a drill bit 344A, A drill bit, such as 344B, can be advanced under power until it exits the anterior edge / side 341 of the glenoid 340. As shown, the hook-like end 331 of the glenoid guide (not shown) applies a force in the rearward direction, i.e. in the direction of the arrow W, while the drill bits 344A, 344B You can move in the opposite direction. According to one or more embodiments, a 2.8 mm drill can be used to form the first hole 349A and the second hole 349B. However, one skilled in the art will appreciate that any size drill can be used to form the first hole 349A and the second hole 349B. According to one or more embodiments, each of the first hole 349A and the second hole 349B can be 5mm below the cortical edge of the glenoid surface at the center, and the hole formed by the drill 349A and 349B are parallel to each other and can be separated by 10 mm between the centers. However, one of ordinary skill in the art can make each of the holes 349A, 349B greater than or less than 5 mm and not necessarily centered under the cortical edge of the glenoid surface It will be understood. Furthermore, those skilled in the art will appreciate that the holes 349A, 349B can be spaced more than 10 mm apart or less than the center. Further, those skilled in the art will appreciate that more or less than two holes can be formed in the glenoid 340, such as, for example, the first hole 349A and the second hole 349B. For example, according to one or more embodiments, one hole or three holes can be formed in the glenoid 340 that exit the anterior side 341 of the glenoid 340.

  Referring to FIG.3E, according to one or more embodiments, after the formation of holes 349A, 349B is complete, a drill (not shown) is inserted into each of the guides, e.g., guides 333, 334 of FIG. (Not shown), leaving the first sleeve 335 and the second sleeve 336 in place in the body with the posterior side of the glenoid 340 engaged, the position of the glenoid 340 Can correspond to holes 349A, 349B formed on the front side / edge 314. In addition, the glenoid guide (not shown) can be removed. According to one or more aspects, a 1 mm pin can be placed inside each of the sleeves 335, 336 to ensure that the sleeves 335, 336 are free of debris. A person skilled in the art will remove any debris from the sleeve 335, 336 using any diameter or smaller diameter member configured to be received by the sleeve 335, 336, and each of the sleeves 335, 336 It will be appreciated that debris can be reliably removed from

  Referring to FIG.3F, a first guidewire 311 and a second guidewire (not shown) are respectively connected to sleeves (not shown) such as, for example, the first sleeve 335 and the second sleeve 336 of FIG.3E. ) Can be placed or inserted into the rear entrance and into the body. In addition, a front inlet (not shown) can be formed, and the first cannula 301 can be placed or inserted into the body through the front inlet. As shown, a first guide wire 311 may be placed through a first hole 349A formed through the first sleeve and through the anterior side / edge 341 of the glenoid 340. As further illustrated, a grasper 360 is disposed within the proximal end (not shown) of the first cannula 301 and exits the first cannula at the distal end 306 of the first cannula 301, It can be used to engage or retrieve the first guidewire 311. According to one or more aspects, the grasper 360 is used to pull each of the first guide wire 311 and the second guide wire through the front inlet and through the first cannula 301 to the outside of the body. Can do.

  Referring to FIG. 3G, a bone block 310 according to embodiments disclosed herein is shown. As shown, the bone block 310 can include a first hole 319A and a second hole 319B. As discussed above, each of the holes 319A, 319B can be configured to receive a first guide wire (not shown) and a second guide wire (not shown). Further, as discussed above, one skilled in the art will appreciate that the bone block 310 can be any bone block or bone graft that can be used in a surgical procedure. For example, in one or more embodiments, the bone block 310 can be used to treat anterior lower shoulder joint instability in the body. Alternatively, the bone block 310 may be an appropriately sized and shaped bone block or bone graft that can be used in surgical procedures involving the hip, knee, wrist, or ankle of the body, for example, Can do. For example, according to one or more embodiments, collecting a cortical iliac crest bone block measuring 20 mm x 8 mm x 8 mm and making it using a preparation board it can. Further, according to one or more embodiments, the holes 319A, 319B are 2.8 mm in diameter and can be 10 mm apart between centers. Holes 319A, 319B can be formed by using a drill to insert through the cortex and exit from the cancellous side of bone block 310. Holes 319A, 319B can be formed to correspond to, for example, a sleeve (not shown) such as sleeve 335, 336 disposed in the glenoid shown in FIG. 3E and / or also in FIG. 3E It can also be formed to correspond to the holes 349A, 349B formed in the glenoid 340 shown. As discussed above, those skilled in the art will appreciate that more than two guidewires, such as guidewires 311, 312 may be used, for example. For example, in one or more embodiments, one, three, four, or more guidewires can be used. Thus, those skilled in the art will also appreciate that more than two or less holes, such as holes 319A, 319B, etc. can be formed through bone block 310, for example. For example, in one or more embodiments, 1, 3, 4, or more holes can be formed through the bone block 310.

  Referring to FIG. 3H, each of the guide wires 311, 312 can be pulled through the first cannula 301 and out of the proximal end 305 of the first cannula 301. Further, each of the guide wires 311 and 312 can be placed through each of the holes 319A and 319B of the bone block 310, respectively. According to one or more embodiments, each of the guide wires 311, 312 can be inserted through the cancellous side of the bone block 310 and can exit through the cortical side of the bone block 310. According to one or more aspects, at least a portion of the guidewires 311, 312 remain posteriorly outside the body, allowing the surgeon to manipulate each of the guidewires 311, 312 posteriorly Although possible, at least a portion of each of the guidewires 311, 312 is disposed within the body and / or is external to the front side.

  Referring to FIGS. 3I and 3J, a first securing member 323 is included to secure the first suture loop 321 and the first securing member 323 to the first loop 317 of the first guidewire 311. The first suture loop 321 can be moved through the first loop 317 of the first guidewire 311 to create or pass the loop, and further back through itself in the direction of arrow D. Can be moved, looped, or passed. Similarly, as shown in FIG. 3J, a second suture loop 322 may be used to secure the second suture loop 322 and the second securing member 324 to the second loop 318 of the second guidewire 312. Can be moved through the second loop 318 of the second guidewire 312 to create or pass the loop, and further moved back through itself to create or pass the loop. it can. Further, according to one or more aspects, to secure the first suture loop 321 and the first securing member 323 to the first guidewire 311 and to the second suture loop 322 and the second For example, the first suture loop 321 and the second suture loop 322 are each substantially separated from the first cannula 301 to secure the securing member 324 to the second guidewire 312. Tension can be applied in the direction. As illustrated, each of the first fixing member 323 and the second fixing member 324 is placed on the bone block 310.

  With reference to FIGS. 3K and 3L, multiple views of a surgical assembly 300 in accordance with embodiments disclosed herein are shown. As shown, the bone block 310 can be placed into the first cannula 301 through the proximal end 305 of the first cannula, through the first cannula 301 and through the anterior entrance into the body. According to one or more aspects, placing the bone block 310 within the body can include pushing the bone block 310 through the first cannula 301 using the obturator 365 into the body. According to one or more aspects, placing the bone block 310 in the body may cause the bone block 310 to pass through the first cannula 301 using each of the first guide wire 311 and the second guide wire 312. Can include pulling into the body. According to one or more aspects, the first guidewire 311 and the second guidewire 312 are used to place the bone block 310 within the first cannula 301 and through the first cannula 301. The bone block 310 can be repositioned or reoriented so that it can be moved. For example, in one or more embodiments, the bone block 310 is moved to the first guide such that the longitudinal axis of the bone block 310 is substantially parallel to the central axis 350 of the first cannula 301. The wire 311 and the second guide wire 312 can be repositioned or reoriented. When the bone block 310 is fully inserted into the first cannula 301, the guide wire 311 emanating from the back, e.g. from the body, such as the shoulder, so as to remove any slack in the guide wire 311 312. 312 can be tensioned. According to one or more aspects, even when using the obturator 365 to push the bone block 310 into the body through the first cannula 301, a slight tension, for example, a guide wire 311, The guide wires 311, 312 can be added and / or maintained from the rear side of 312.

  As shown in FIG. 3L, the bone block 310 can exit from the distal end 306 of the first cannula 301 at the body site near the anterior edge / side 341 of the glenoid 340 inside the body. . As discussed above, in one or more embodiments, an obturator (not shown) is used to push the bone block 310 into the body in the direction of the anterior edge / side 341 of the glenoid 340. Can do. Further, in one or more embodiments, when the bone block 310 is pushed into the body using an obturator, the first guide wire 311 and the second guide wire 312 respectively placed through the holes 349A, 349B In use, a slight tension can be applied to and / or maintained in the bone block 310. Alternatively, in one or more embodiments, a first guide wire 311 and a second guide wire 312 placed through holes 349A, 349B, respectively, without using an obturator, The bone block 310 can be pulled into the body in the direction of the front edge / side 341 of 340.

  Referring to FIG.3M, each of the guidewires (not shown) such as guidewires 311, 312 shown in FIG.3L disposed within sleeves 335, 336 can be pulled back or tensioned, for example. Also, the bone block 310 can exit the distal end 306 of the first cannula 301 and maneuver the bone block 310 until it is placed in the intended position along the anterior neck of the glenoid 340 and re-orientate Can be made or rearranged. According to one or more aspects, the cancellous portion of the bone block 310 can be secured to the glenoid 340, such as the neck of the glenoid 340, for example. Further, according to one or more aspects, for example, using a grasper (not shown) such as grasper 360 shown in FIG. It can be redirected or repositioned. While placing the bone block 310 in the body, a slight forward tension on each of the suture loops 321, 322 can be maintained, and thus the first fixation member 323 and the second fixation member 324 Each is engaged with the bone block 310, but the guide wire 311, 312 can be pulled backwards to place the bone block 310 on the glenoid 340.

  With reference to FIGS. 3N and 3O according to one or more embodiments, each of the first suture loop 321 and the second suture loop 322 is disengaged from the guidewires 311, 312 respectively, Can be removed from the body. As shown, in addition to the first cannula 301, a second cannula 302 can be placed in the body in the vicinity of the glenoid 340 and the bone block 310. According to one or more aspects, the first securing member 323 and the first suture loop 321 can be disengaged from the first guidewire 311 and removed from the body through the second cannula 302. it can. According to one or more aspects, for example, a grasper (not shown), such as grasper 360 shown in FIG. 3F, removes first fixation member 323 and first suture loop 321 from the body. The second fixation member 324 remains engaged with the bone block 310, although it can be placed through the second cannula 302 used for the purpose. As discussed above, in one or more embodiments, in order to remove or disengage the first suture loop 321 from the first guidewire 311, the surgeon may 323 can be pulled in a direction substantially away from the first guidewire 311. By pulling the first securing member 323 in a direction substantially away from the first guide wire 311, the first suture loop 321 is unwound or released, and the first guide wire 311 is released from the first guide wire 311. The engagement can be released.

  After the first fixation member 323 and the first suture loop 321 are removed from the body, the needle guidewire 353 is placed in the body, for example, in the proximal end 307 of the second cannula 302, and Exit from the distal end 308 of the second cannula 302 and enter a subscapular muscle entrance that is aligned with the hole in the bone graft 310, e.g., the holes 319A, 319B in the bone graft 310 shown in FIG. Can be created. According to one or more aspects, once in the joint, the cannulated obturator (not shown) and the fixed cannula (not shown) can be inserted over the needle guidewire 353. In accordance with one or more aspects, maintain safety of, for example, engagement of the bone block 310 with respect to the glenoid 340 when the first guidewire 311 is removed anteriorly through the second cannula 302. To aid in this, tension can be applied rearwardly to the second guidewire 312.

  Referring to FIGS. 3P-3R, for example, a sleeve (not shown) such as sleeve 335 aligned with hole 349A in glenoid 340 and engaged to the posterior side of glenoid 340 is connected to the first fixing screw. Can be removed to accommodate 351 arrangements. According to one or more aspects, a first fixation screw 351 is inserted into the proximal end 307 of the second cannula 302 and passed through the second cannula 302 over the needle guidewire 353. And the first fixation screw 351 engages the bone block 310 and until the bone block 310 is secured to the anterior side / edge 341 of the glenoid 340, It can be driven into the body by a drill or screwdriver 334. After the first fixation screw 351 is secured in the bone block 310 within the body, the needle guidewire 353 can be removed from the body.

  Subsequently, according to one or more aspects, the second fixation member 324 and the second suture loop 322 are described above with respect to the first fixation member 323 and the first suture loop 321. It can be removed from the body through the first cannula 301 in a similar manner. According to one or more aspects, the second fixation screw 352 can be secured to the glenoid 340 in a manner similar to that described above with respect to the first fixation screw 351. It can be fixed to the bone block 310. For example, a sleeve (not shown) such as sleeve 336 that is aligned with hole 349B in glenoid 340 and engages the posterior side of glenoid 340 is removed to accommodate the placement of second fixation screw 352. be able to. In addition, a needle guidewire 353 can be placed through the first cannula 301. Further, according to one or more aspects, the second fixation screw 352 is passed through the first cannula 301 over the needle guidewire 353, and the second fixation screw 352 engages the bone block 310. And can be driven into the body by a drill or screwdriver until the bone block 310 is secured in the glenoid.

  One skilled in the art would use a first screw 351 through the bone block 310 in the glenoid 340 and a manual screwdriver, powered drill, or any means to secure the screw into the surface. It will be appreciated that the second securing screw 352 can be secured. Further, according to one or more aspects, each of the first and second fixation screws 352 can be a 34 mm cannulated screw. However, those skilled in the art will appreciate that any size fixation screw adapted to be used with bone block 310 may be used. Further, those skilled in the art will appreciate that more or less than two guidewires can be used, such as, for example, guidewires 311, 312. For example, in one or more embodiments, one, three, four, or more guidewires can be used.

  According to one or more aspects, a fastener may be placed between the glenoid 340 and the bone block 310 along the anterior edge of the glenoid 340 and away from the path of the fixation screws 351, 352. it can. Further, according to one or more aspects, a suture can be passed through the joint lip and joint capsule and secured to an upper surface, such as a cortical surface of the bone block 310, for example.

  A surgical kit according to embodiments disclosed herein includes a defined center passing through a hole, a proximal end, a distal end, and a hole formed through and configured to receive a bone block A first cannula having an axis, a first guide wire, a second guide wire, a first suture loop comprising a first securing member, and a second suture comprising a second securing member Loops.

  The kit also includes a glenoid guide having a hooked end, a second cannula having a hole formed therethrough, a proximal end, and a distal end, a grasper, an obturator, and a needle guidewire. And at least one screw to be cannulated and a drill configured to secure the at least one screw in the bone.

  Embodiments disclosed herein are advantageous because they can provide surgical assemblies, methods, and kits that can simplify and improve techniques for treating anterior shoulder instability. is there. As discussed above, pushing / pulling a bone block in the body using a grasper and securing the bone block using a suture are difficult for the surgeon and may result in time. There is. The use of at least one screw to secure the bone block and the use of guidewires, suture loops, and fixation members to manipulate and secure the bone block within the body has been identified by the surgeon. It can help treat shoulder joint instability more quickly, accurately and effectively.

  Although embodiments have been described with respect to a limited number of embodiments, those skilled in the art having the benefit of this disclosure can devise other embodiments that do not depart from the scope of the embodiments disclosed herein. Will be understood. Accordingly, the scope of the embodiments disclosed herein should be limited only by the attached embodiments.

100 Surgical assembly
101 first cannula
105 Proximal end
109 holes
110 bone blocks
111 First guidewire
112 Second guidewire
117 First loop
118 second loop
121 First suture loop
122 Second suture loop
123 First fixing member, first fixing element
124 Second fixing member, second fixing element
150 Center axis
200 Surgical assembly
201 first cannula
205 proximal end
209 holes
210 bone blocks
211 First guidewire
212 Second guidewire
217 1st loop
218 Second loop
219A hole
219B hole
221 First suture loop
222 Second suture loop
223 First fixing member, first fixing element
224 Second fixing member
250 center axis
300 Surgical assembly
301 first cannula
302 Second cannula
305 Proximal end
306 Distal end
307 Proximal end
308 Distal end
310 bone blocks, bone grafts
311 1st guidewire
312 Second guidewire
317 1st loop
318 2nd loop
319A 1st hole
319B second hole
321 First suture loop
322 Second suture loop
323 First fixing member
324 Second fixing member
330 Glenoid guide
331 Hook end
333 First Guide
334 Second guide, drill or screwdriver
335 1st sleeve
336 2nd sleeve
337 Ratchet teeth
340 Glenoid
341 Front edge / side
344A drill bit
344B drill bit
349A 1st hole
349B second hole
350 Center axis
351 1st fixing screw
352 Second fixing screw
353 needle guidewire
360 gripper
365 obturator
D arrow
P arrow
W arrow

Claims (20)

A surgical assembly comprising:
A first guide wire;
A second guidewire and a first suture loop;
A second suture loop;
A first fixing element;
A second fixing element,
Each of the first guidewire and the second guidewire is configured to be received by a bone block;
A surgical assembly, wherein the first anchoring element is coupled to the first suture loop and the second anchoring element is coupled to the second suture loop.   A first cannula, wherein the first cannula has a hole formed therethrough, a proximal end, a distal end, and a central axis defined through the first cannula; The assembly according to claim 1.   The first suture loop is configured to be secured to the first guidewire, and the second suture loop is configured to be secured to the second guidewire. Item 4. The assembly according to Item 1.   The assembly of claim 1, wherein each of the first fixation element and the second fixation element has a substantially spherical shape.   The assembly of claim 1, wherein the first guidewire comprises a first loop and the second guidewire comprises a second loop.   The first suture loop is configured to be secured to the first loop of the first guidewire, and the second suture loop is configured to be the second guidewire of the second guidewire. 6. The assembly of claim 5, wherein the assembly is configured to be secured to the loop.   The assembly of claim 1, wherein each of the first suture loop and the second suture loop is a continuous loop. Forming a rear entrance in the body;
Forming a front entrance in the body;
Inserting a first guide wire and a second guide wire into the rear inlet;
Pulling each of the first guide wire and the second guide wire out of the body through the front entrance;
Placing each of the first guide wire and the second guide wire through a bone block;
Securing a first suture loop to the first guidewire and a second suture loop to the second guidewire;
Using the first guide wire and the second guide wire to place the bone block through the anterior entrance into the body;
Removing each of the first suture loop and the second suture loop;
Fixing the bone block in the body with respect to the glenoid fossa.   9. The method of claim 8, further comprising positioning a guide comprising a hook through the posterior entrance into the body.   10. The method of claim 9, further comprising positioning the hook of the guide on the anterior side of the glenoid.   9. The method of claim 8, further comprising forming a first hole and a second hole through the glenoid from the posterior side of the glenoid to the anterior side of the glenoid.   Further comprising inserting a first cannula through the anterior entrance into the body, the first cannula passing through a hole formed therethrough, a proximal end, a distal end, and through 9. A method according to claim 8, comprising a central axis.   The step of placing the bone block in the body orients the bone block such that a longitudinal axis of the bone block is substantially parallel to the central axis of the first cannula. 13. The method of claim 12, comprising the step of attaching.   The step of pulling each of the first guide wire and the second guide wire out of the body comprises passing each of the first guide wire and the second guide wire through the front entrance of the body. 9. The method of claim 8, comprising using a grasper to pull out.   9. The method of claim 8, wherein the step of placing the bone block in the body comprises pushing the bone block through the first cannula using an obturator and into the body. .   The step of placing the bone block in the body pulls the bone block through the first cannula into the body using each of the first guide wire and the second guide wire. 9. The method of claim 8, comprising steps.   9. The method of claim 8, wherein the step of securing the bone block into the body comprises securing at least one screw through the bone block and into the glenoid.   9. The method of claim 8, further comprising removing each of the first guidewire and the second guidewire from the body. A first cannula, a hole formed through the first cannula and configured to receive a bone block; a proximal end; a distal end; and through the first cannula A first cannula having a central axis defined as
A first guide wire;
A second guide wire;
A first suture loop comprising a first securing member;
A surgical kit comprising a second suture loop comprising a second securing member. A glenoid guide having a hook-like end;
A second cannula, the second cannula having a hole formed therethrough, a proximal end, and a distal end;
A gripper;
With an obturator,
A needle guide wire;
At least one screw to be cannulated;
20. The kit of claim 19, further comprising a drill configured to secure the at least one screw to the bone.

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